Disease Description (Causes and Symptoms)
- Disease name clarification: Chondromalacia refers to findings of softening and damage of the patellar cartilage and, clinically, is closely associated with patellofemoral pain syndrome (PFPS), with the two terms often used together.
- Pathophysiology summary: The cartilage between the patella and femur becomes weakened (softened) by repetitive overloading or trauma, resulting in cracking, delamination, and erosion. Abnormal patellar tracking or poor knee alignment causes localized concentration of stress, worsening cartilage damage.
- Main causes: Knee trauma (contusion, dislocation, fracture), excessive repetitive exercise (running, jumping), abnormal patellar alignment, muscle imbalance (especially weakness of the quadriceps and vastus medialis), and excessive joint use.
- Typical symptoms: Dull pain and tenderness behind the patella (front of the knee), worsening pain when going up or down stairs or standing up after sitting (theater sign), stiffness after sitting for a long time, knee locking or catching, and sometimes clicking or creaking sounds (crepitus). Pain varies depending on activity.
Treatment Methods and Precautions
- Conservative treatment (first-line):
- Activity modification: Avoid triggering movements such as squatting, deep squats, going up and down stairs, and sitting for long periods.
- Medication: Control pain with nonsteroidal anti-inflammatory drugs (NSAIDs) for a short period.
- Physical therapy: Strengthening the quadriceps (especially the VMO), stretching and strengthening the hamstrings and hip muscles, retraining muscle balance, and exercises to restore joint mobility.
- Adjunctive techniques: Patellar taping (Kickstrap), knee braces/pads, and custom foot orthotics (when correcting alignment).
- Rehabilitation period: In mild cases, improvement can be expected with 6–12 weeks of regular rehabilitation.
- Procedural and surgical treatment (when conservative treatment fails):
- Arthroscopic debridement and abrasion, smoothing of the cartilage surface, and release of the lateral patellar retinaculum (lateral release), among others.
- When abnormal alignment is the main cause, realignment surgery such as tibial tubercle transfer may be considered.
- Cartilage restoration procedures (microfracture, autologous cartilage transplantation, etc.) are selective and depend on the size of the lesion and the patient’s condition.
- Other treatment options (with varying levels of evidence): Injection treatments such as hyaluronic acid injections and PRP are used in some patients, but their effectiveness has not been clearly established.
- Precautions/complications:
- Without early treatment and adherence to rehabilitation, the condition may progress to chronic pain and functional impairment, with a risk of worsening into patellofemoral arthritis.
- Pain may not disappear completely even after surgery, and general surgical complications such as infection and joint stiffness may occur.
- Self-care considerations: Manage body weight, engage in regular strength and flexibility exercises, and gradually resume high-intensity impact activities.
Outpatient Visit Checklist (Items to Bring and Points to Check Before the Visit)
- Materials to bring: A list of current medications (including dosages), allergy history, previous knee imaging results (X-rays and MRI) or the dates they were performed, and records of previous treatment (physical therapy, injections, and surgery).
- Symptom record: When symptoms began, factors that worsen or improve them (which movements cause severe pain), pain intensity (0–10), pain frequency and limitations in daily activities, and whether there was any trauma immediately before the pain began.
- Lifestyle information: Types and frequency of exercise, occupation (whether it involves extensive use of the knees), and changes in body weight.
- Other preparation: Mark the exact location of the pain with a finger and bring it with you (a photo, if possible), and bring the contact information of hospitals where you recently underwent examinations or treatment.
(If the patient writes down example questions in advance and brings them to the appointment, this can help with diagnosis and treatment planning.)
General Example Questions to Ask the Doctor
- "What is the exact cause of this pain? Do I need an MRI?"
- "What specific non-surgical treatment program (physical therapy and exercise) do you recommend? How often should I do it?"
- "What is the recommended duration of medication, such as an NSAID, and what are its side effects?"
- "How likely is it that surgery will be necessary, and what results can I expect from surgery?"
- "When can I safely resume daily activities and exercise?"
Examples of Condition-Specific Questions
- "During which knee movements—going up or down stairs, running, or sitting for a long time—is the pain most severe? Please describe the pattern of the pain."
- "Do you hear a creaking sound or experience locking when moving your knee? Is it accompanied by pain when it happens?"